Mallory-Weiss syndrome is a condition characterized by a tear in the inner wall of the esophagus that borders the stomach. The tear can cause complaints, such as vomiting blood or bloody stools.
Mallory-Weiss syndrome usually resolves on its own within 7–10 days. However, the bleeding may last longer and be persistent if the tear is large or deep. This condition requires surgery to stop the bleeding.
Causes of Mallory-Weiss Syndrome
Mallory-Weiss syndrome is generally caused by increased pressure in the upper gastrointestinal tract, for example from persistent vomiting. This condition can be caused by stomach disorders, excessive consumption of alcoholic beverages, and bulimia.
Age is a risk factor for Mallory-Weiss syndrome. Individuals aged 40–60 years are more at risk of suffering from this condition. In addition, Mallory-Weiss syndrome is also more common in women than men.
Some other factors that can also increase the risk of developing Mallory-Weiss syndrome are:
- hiatus hernia
- Injuries to the chest or abdomen
- Hiccups that are heavy or last a long time
- Gastritis
- Strong and long cough
- Seizures
- Often lift heavy weights
- Receive cardiopulmonary resuscitation
- Hyperemesis gravidarum (vomiting during pregnancy)
- Give birth
- Undergoing chemotherapy
- Use of aspirin or non-steroidal anti-inflammatory drugs
Symptoms of Mallory-Weiss Syndrome
Mallory-Weiss syndrome does not always show symptoms, especially if the condition is still relatively mild. Complaints that generally appear in patients with Mallory-Weiss Syndrome include:
- Heartburn that can penetrate to the back
- Vomiting without expelling anything
- Vomiting blood or vomiting with black flakes like coffee grounds
- Pale
- Dizziness and weakness
- Hard to breathe
- Faint
- Stool that is bloody or black
When to go to the doctor
Go to the doctor or the emergency room immediately if you experience vomiting blood or there is blood in the stool. You also need to get yourself checked if you have heartburn and nausea and vomiting that doesn't get better within 1 week. Examination can differentiate the symptoms of Mallory-Weiss syndrome from those of other disorders, such as:
- stomach ulcer
- Boerhaave Sindrom syndrome
- Zollinger-Ellison syndrome
- Severe erosive gastritis
- Perforation or ruptured esophagus
Diagnosis of Mallory-Weiss Syndrome
To diagnose Mallory-Weiss syndrome, the doctor will first ask about the symptoms experienced, medical history, and habits of the patient, including the habit of consuming alcoholic beverages. After that, the doctor will perform a thorough physical examination.
If the patient shows signs of severe bleeding, the doctor will suggest an endoscopy so that the source of the bleeding can be identified immediately. Endoscopy is performed using an endoscope, which is a device in the form of a camera tube connected to a monitor.
An endoscope will be inserted through the mouth to look at the condition of the esophagus and locate the tear. During this procedure, the patient will be given a sedative and pain reliever.
Bleeding from a tear in the upper gastrointestinal tract can cause red blood cell levels to drop. Therefore, the doctor will also perform a complete blood count to check the level of red blood cells in the patient's body.
If the bleeding is so severe that the tear is difficult to find, the doctor will perform an angiography. This procedure is done by injecting a contrast substance into a vein using a catheter and the help of X-rays.
Mallory-Weiss Syndrome Treatment
Most cases of Mallory-Weiss syndrome do not require treatment. Usually, the bleeding will stop within 7–10 days. However, further action needs to be taken if the bleeding does not stop or gets worse. Actions that doctors can take include:
Endoscopic therapy
In addition to examination, endoscopy can also be performed to treat a tear if the bleeding does not subside. Treatment is usually sclerotherapy or coagulation therapy to block the torn blood vessels.
Operation
Surgery is done if other medical measures can not stop the bleeding. One of the surgical techniques performed is laparoscopy. The goal is to suture the tear so the bleeding can stop immediately.
Drugs
A tear in the upper gastrointestinal tract can be triggered by stomach acid. To overcome this, the doctor will prescribe drugs, such as famotidine or lansoprazole, to reduce the production of acid in the stomach. However, the risks and benefits are still debated.
Some supportive therapy can also be done to improve the patient's condition. For example, blood transfusions or intravenous fluids may be given if the patient has lost a lot of blood or is dehydrated.
Mallory-Weiss Syndrome Complications
If the bleeding that occurs is not treated immediately or lasts a long time, Mallory Weiss syndrome can cause complications such as:
- Anemia
- Hypoxia (lack of oxygen)
- Hypovolemic shock
- Boerhaave's syndrome or tearing of the entire wall of the esophagus
- Death
In addition, complications can also be caused by medical procedures, such as a hole in the esophagus or bleeding during endoscopic therapy.
Mallory-Weiss Syndrome Prevention
Some things that can be done to prevent a tear in the esophagus are:
- Keep food clean to avoid gastrointestinal infections that can cause vomiting.
- Avoid things that can cause a severe cough, such as smoking.
- Avoid excessive consumption of alcoholic beverages.
- Avoid straining too much or lifting heavy weights alone.
- Consult your doctor before using medicines with side effects of stomach bleeding, such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).
- Avoid foods that have the potential to injure the upper digestive tract, such as nuts, acidic foods, and spicy foods, especially if you have gastritis or acid reflux disease.
- Immediately see a doctor if you experience symptoms of vomiting that do not improve.
